Use of il-1 beta binding antibodies for treating peripheral arterial disease

ABSTRACT

The present invention relates to a method for treating or alleviating the symptoms of peripheral arterial disease (PAD) in a subject, comprising administering about 25 mg to about 300 mg of an IL-1β binding antibody or functional fragment thereof.

TECHNICAL FIELD

The present disclosure relates to a novel use and dosage regimens of anIL-1β binding antibody or functional fragments thereof, for treating oralleviating the symptoms of peripheral arterial disease.

BACKGROUND OF THE DISCLOSURE

Periferal arterial disease PAD, also known as peripheral vasculardisease (PVD) or peripheral arterial occlusive disease (PAOD) refers tothe obstruction of large arteries not within the coronary, aortic archvasculature, or brain. PAD can result from atherosclerosis, inflammatoryprocesses leading to stenosis, an embolism, or thrombus formation. Itcauses either acute or chronic ischemia (lack of blood supply). PAD is aform of atherosclerotic disease that affects the peripheral arteries. Itcommonly manifests in the blood vessels of the legs as claudication, anintermittent pain that occurs with exercise and/or at rest. PAD isprevalent in smokers and diabetics; its incidence increases with age.PAD affects ˜10 million individuals in the US alone. Management of PADoverlaps with coronary disease risk modification, but approved medicaltherapies for PAD affect platelet viscosity to improve blood flow toperipheral muscles and do not modify disease. PAD shares pathologicfeatures with coronary atherosclerosis, such a chronic vascularinflammation. Interleukins (ILs) are key mediators in the chronicvascular inflammatory response. IL-1β activates endothelial cells,leading to the upregulation of adhesion molecules that promoteinflammatory cell adhesion to the vessel wall. IL-1β also increasesextracellular matrix and collagen deposition, thereby contributing toplaque burden and arterial wall thickening. Antagonism of IL-1β is anattractive target to ameliorating vessel wall inflammation associatedwith atherosclerosis.

Inhibition of IL-1 activity is being currently explored for a number ofcardiovascular indications via different mechanisms. Anakinra (Kineret)is a human interleukin-1 receptor antagonist that requires dailysubcutaneous dosing of approximately 100 mg for efficacy. TheMRC-ILA-HEART study is a clinical trial investigating the effects ofanakinra upon markers of inflammation in patients with non-ST elevationmyocardial infarction (NSTEMI) (Crossman, et al., 2008).

ACZ885 (canakinumab) is a high-affinity, fully human monoclonal antibodyto interleukin-1β, developed originally for the treatment ofIL-1β-driven inflammatory diseases. Canakinumab has been approved underthe trade name ILARIS® in the US for patients ≥4 year of age withCryopyrin-Associated Periodic Syndromes (CAPS), [FamilialCold-Associated Syndrome (FCAS) and Muckle-Wells syndrome (MWS)phenotypes included, Canakinumab has also received regulatory approvalsfor treatment of SJIA and gout.

SUMMARY OF THE DISCLOSURE

Accordingly, in a one aspect, the present disclosure is directed to amethod for treating or alleviating the symptoms of peripheral arterialdisease (PAD) in a subject, comprising administering about 25 mg toabout 300 mg of an IL-1β binding antibody or functional fragmentthereof. The therapy of the invention will decrease the amount of plaquein peripheral arteries, and/or may also improve endothelial function topromote more blood flow, and thereby improve the ability of patients toambulate without pain.

Accordingly, in a another aspect, the present disclosure is directed toan IL-1β binding antibody or a functional fragment thereof for use as amedicament for treating or alleviating the symptoms of peripheralarterial disease (PAD) in a subject, comprising administering about 25mg to about 300 mg of an IL-1β binding antibody or functional fragmentthereof.

Accordingly, in yet another aspect, the present disclosure is directedto the use of an IL-1β binding antibody or a functional fragment thereoffor the manufacture of a medicament for treating or alleviating thesymptoms of peripheral arterial disease (PAD) in a subject, comprisingadministering about 25 mg to about 300 mg of an IL-1β binding antibodyor functional fragment thereof.

Further features and advantages of the disclosure will become apparentfrom the following detailed description of the invention.

DETAILED DESCRIPTION OF THE DISCLOSURE

Periferal arterial disease PAD, also known as peripheral vasculardisease (PVD) or peripheral arterial occlusive disease (PAOD) refers tothe obstruction of large arteries not within the coronary, aortic archvasculature, or brain. PAD can result from atherosclerosis, inflammatoryprocesses leading to stenosis, an embolism, or thrombus formation. Itcauses either acute or chronic ischemia (lack of blood supply). OftenPAD is a term used to refer to atherosclerotic blockages found in thelower extremity.

The present invention provides a method for treating or alleviating thesymptoms of peripheral arterial disease (PAD) in a subject, comprisingadministering about 25 mg to about 300 mg of an IL-1β binding antibodyor functional fragment thereof. In one embodiment of any method of theinvention, the subject has moderate PAD. Moderate PAD is associated withan ankle-brachial index (ABI) below 0.8. ABI or ABPI (ankle brachialpressure index) is determined by comparing the blood pressure measuredin the ankles to the blood pressure measured in the arms. Patients withsevere ischemic disease and severe PAD has an ABI below 0.5 or below 0.4and these patients can also benefit from treatment with the methods anduses according to the present invention. In one embodiment the subjectis exhibiting an ankle-brachial index between 0.5 and 0.85 in at leastone leg before treatment. In another embodiment, the subject isexhibiting an ankle-brachial index less than 0.5 in at least one leg orthe subject is exhibiting an ankle-brachial index less than 0.9 in atleast one leg.

Moderate PAD is associated with the subject having symptomaticintermittent claudication, i.e., the patients exhibiting severe painwhen walking relatively short distances e.g., less than 150 m or lessthan 400 m.

In one embodiment of any method of the invention, the subject hasimproved vascular structure and function after 3 months of treatment orafter 12 months of treatment. In one embodiment, reduced plaque burdenin the peripheral artery walls of said subject is observed after atleast 3 months of treatment or at least 12 months of treatment. Thereduced plaque burden compared to before treatment in said subject canbe determined in the superficial femoral artery after at least 3 monthsof treatment or after at least 12 months of treatment. The improvementsof vascular structure and function can be determined by magneticresonance imaging (MRI).

The subject's ability to walk for 6 min will improve after treatmentwith the methods and uses according to the present invention.

IL-1β binding antibody or functional fragment thereof is administeredevery 2 weeks, twice a month, monthly, every 6 weeks, every 2 months,every 3 months, every 4 months, every 5 months, or every 6 months fromthe first administration. In one embodiment, said IL-1β binding antibodyor functional fragment thereof is administered monthly.

In one embodiment, said method comprises administering about 25, 50, 75,80, 100, 125, 150, 175, 200, 225, 250, 275, 300 mg or any combinationthereof of the IL-1β binding antibody or functional fragment thereof.Said method comprises administering about 50 mg, about 80 mg or about200 mg or about 300 mg of the IL-1β binding antibody or functionalfragment thereof. In one embodiment, said method comprises administeringabout 150 mg of the IL-1β binding antibody or functional fragmentthereof.

In another embodiment said method comprising administering the patientan additional dose of about 25 mg to about 300 mg of the IL-1β bindingantibody or functional fragment thereof at week 2, week 4 or week 6 fromthe first administration.

In one embodiment of any method of the invention, said IL-1β bindingantibody or functional fragment thereof is an IL-1β binding antibody. Inone embodiment of any method of the invention, said IL-113 bindingantibody or functional fragment thereof is capable of inhibiting thebinding of IL-1β to its receptor and has a K_(D) for binding to IL-1β ofabout 50 pM or less.

In other embodiments of any method of the invention said IL-1β bindingantibody is selected from the group consisting of:

-   -   a) an IL-1β binding antibody directed to an antigenic epitope of        human IL-1β which includes the loop comprising the Glu64 residue        of the mature IL-1β, wherein said IL-1β binding antibody is        capable of inhibiting the binding of IL-1β to its receptor, and        further wherein said IL-1β binding antibody has a K_(D) for        binding to IL-1β of about 50 pM or less;    -   b) an IL-1β binding antibody that competes with the binding of        an IL-1β binding antibody comprising a VH domain comprising SEQ        ID NO:1 and a VL domain comprising SEQ ID NO:2;    -   c) an IL-1β binding antibody comprising the three CDRs of SEQ ID        NO:3, SEQ ID NO:4, SEQ ID NO:5;    -   d) an anti-IL-1β binding antibody comprising the three CDRs of        SEQ ID NO:6, SEQ ID NO:7, SEQ ID NO:8;    -   e) an anti-IL-1β binding antibody comprising the three CDRs of        SEQ ID NO:3, SEQ ID NO:4, SEQ ID NO:5 and the three CDRs of SEQ        ID NO:6, SEQ ID NO:7, SEQ ID NO:8;    -   f) an anti-IL-1β binding antibody comprising a VH domain        comprising SEQ ID NO:1;    -   g) an anti-IL-1β binding antibody comprising a VL domain        comprising SEQ ID NO:2;    -   h) an anti-IL-1β binding antibody comprising a VH domain        comprising SEQ ID NO:1 and a VL domain comprising SEQ ID NO:2.

In one embodiment of any method of the invention, said IL-1β bindingantibody or fragment thereof comprises the 3 CDRs of SEQ ID NO:1 are setforth in SEQ ID NO:3, 4, and 5 and wherein the 3 CDRs of SEQ ID NO:2 areset forth in SEQ ID NO:6, 7, and 8.

In other embodiments of any method of the invention, the IL-1β bindingantibody comprises:

a) a VH having a first CDR having 0, 1 or 2 amino acid substitutions incomparison to the CDR set forth in SEQ ID NO:3, a second CDR having 0, 1or 2 amino acid substitutions in comparison to the CDR set forth in SEQID NO:3, a third CDR having 0, 1 or 2 amino acid substitutions incomparison to the CDR set forth in SEQ ID NO:5; andb) a VL having a first CDR having 0, 1 or 2 amino acid substitutions incomparison to the CDR set forth in SEQ ID NO:6, a second CDR having 0, 1or 2 amino acid substitutions in comparison to the CDR set forth in SEQID NO:7, and a third CDR having 0, 1 or 2 amino acid substitutions incomparison to the CDR set forth in SEQ ID NO:8, wherein said antibodyhas a K_(D) for IL-1beta of 50 pM or less and wherein said antibodyinhibits the binding of IL-1β to its receptor.

Substituted amino acids are ideally conservative substitutions, and oncesubstituted a skilled artisan could use an assay such as those describedin WO02/16436.

In some embodiments of any of the method described above, the antibodyor fragment binds to human IL-1β with a dissociation constant of about50 pM or less. In some embodiments, the antibody or fragment binds tohuman IL-Iβ with a dissociation constant of about 500 pM or less. Insome embodiments, the IL-1β binding antibody or functional fragmentthereof binds to human IL-Iβ with a dissociation constant of about 250pM or less. In some embodiments, the IL-1β binding antibody orfunctional fragment thereof binds to human IL-1β with a dissociationconstant of about 100 pM or less. In some embodiments of any of themethods described above, the IL-113 binding antibody or functionalfragment thereof binds to human IL-1β with a dissociation constant ofabout 5 pM or less. In some embodiments, the IL-1β binding antibody orfunctional fragment thereof binds to human IL-1β with a dissociationconstant of about 1 pM or less. In some embodiments, the IL-1β bindingantibody or functional fragment thereof binds to human IL-1β withdissociation constant of about 0.3 pM or less.

In some embodiments of any and/or all of the methods described above,the IL-1β binding antibody or functional fragment thereof is aneutralizing antibody.

One example of an IL-1β binding antibody is canakinumab which has aheavy chain variable region (VH) is set forth as SEQ ID NO:1 of thesequence listing. CDR1 of the VH of canakinumab is set forth as SEQ IDNO:3 of the sequence listing. CDR2 of the VH of canakinumab is set forthas SEQ ID NO:4 of the sequence listing. CDR3 of the VH of canakinumab isset forth as SEQ ID NO:5 of the sequence listing.

The canakinumab light chain variable region (VL) is set forth as SEQ IDNO:2 of the sequence listing. CDR1 of the VL of canakinumab is set forthas SEQ ID NO:6 of the sequence listing. CDR2 of the VL of canakinumab isset forth as SEQ ID NO:7 of the sequence listing. CDR3 of the VL ofcanakinumab is set forth as SEQ ID NO:8 of the sequence listing.

In some embodiments of any and/or all of the methods described above,the anti-IL-1β binding antibody or binding fragment thereof competeswith the binding of an antibody having the light chain variable regionof SEQ ID NO:1 and the heavy chain variable region of SEQ ID NO:2.

In some embodiments, the disclosed methods comprise administering ananti-IL-1β binding antibody having the three CDRs of SEQ ID NO:1. Infurther embodiments, the three CDRs of SEQ ID NO:1 are set forth as SEQID NOs:3-5. In some embodiments, the disclosed methods compriseadministering an anti-IL-1β binding antibody having the three CDRs ofSEQ ID NO:2. In further embodiments, the three CDRs of SEQ ID NO:2 areset forth as SEQ ID NOs:6-8.

Preferably the IL-113 binding antibody is canakinumab. Canakinumab is afully human monoclonal anti-human IL-1β antibody of the IgG1/k isotype,being developed for the treatment of IL-1β driven inflammatory diseases.It is designed to bind to human IL-1β and thus blocks the interaction ofthis cytokine with its receptors. The antagonism of the IL-1β mediatedinflammation using canakinumab in lowering high sensitivity C-reactiveprotein (hsCRP) and other inflammatory marker levels has shown an acutephase response in patients with Cryopyrin-Associated Periodic Syndrome(CAPS) and rheumatoid arthritis. This evidence has been replicated inpatients with type 2 diabetes mellitus (T2DM) using canakinumab and withother IL-1β antibody therapies in development.

Canakinumab is disclosed in WO02/16436 which is hereby incorporated byreference in its entirety.

In other embodiments of any method of the invention, said IL-1β bindingantibody or functional fragment thereof is selected from the groupconsisting of gevokizumab, LY-2189102 or AMG-108.

Said IL-1β binding antibody or functional fragment thereof isadministered parentally, e.g., intravenously or subcutaneously.Preferably, canakinumab is administered subcutanously. Canakinumab canbe administered in a reconstituted formulation comprising canakinumab ata concentration of 10-200 mg/ml, 270 mM sucrose, 30 mM histidine and0.06% polysorbate 80, wherein the pH of the formulation is 6.5.Canakinumab can also be administered in a liquid formulation comprisingcanakinumab at a concentration of 10-200 mg/ml, mannitol, histidine andpolysorbate 80, wherein the pH of the formulation is 5.5-7.0.Canakinumab can also be administered in a liquid formulation comprisingcanakinumab at concentration: 10-200 mg/ml, 270 mM mannitol, 20 mMhistidine and 0.04% polysorbate 80, wherein the pH of the formulation is6.5.

Said IL-1β binding antibody e.g. canakinumab or functional fragment canbe administered to the patient in a liquid form or lyophilized form forreconstitution contained in a prefilled syringe. In one embodiment, theprefilled syringe is contained in an autoinjector.

In other embodiments of any method of the invention, said patient isconcomitantly receiving a statin such as lovastatin, pravastatin,simvastatin, fluvastatin, atorvastatin, cerivastatin, mevastatin,pitavastatin, rosuvastatin Preferably said patient is concomitantlyreceiving simvastatin, atorvastatin, rosuvastatin or aspirin. In oneaspect, said patient is concomitantly receiving cilostazol orpentoxyfylline. In other aspects, said patient is concomitantlyreceiving beta-adrenergic blocking drugs such as esmolol, metoprolol,nadolol, penbutolol; or an angiotensin-converting enzyme (ACE) inhibitorsuch as ramipril, ramiprilat, captopril, lisinopril; or an angiotensinII receptor blocker such as losartan, valsartan, olmesartan, irbesartan,candesartan, telmisartan, eprosartan; or an inhibitor of plateletaggregation such clopidogrel, elinogrel, prasugrel, cangrelor,ticagrelor, ticlopidine, dipyridamole, picodamide eptifibatide,abciximab, eptifibatide, tirofiban or terutroban; or a nitrate such asglyceryl trinitrate (GTN)/nitroglycerin, isosorbide dinitrate,isosorbide mononitrate.

According to another aspect of the invention, an IL-1β binding antibodyor a functional fragment thereof for use as a medicament for treating oralleviating the symptoms of peripheral arterial disease (PAD) in asubject, comprising administering about 25 mg to about 300 mg of anIL-1β binding antibody or functional fragment thereof.

According yet another aspect of the invention, the use of an IL-1βbinding antibody or a functional fragment thereof is provided for themanufacture of a medicament for treating or alleviating the symptoms ofperipheral arterial disease (PAD) in a subject, comprising administeringabout 25 mg to about 300 mg of an IL-113 binding antibody or functionalfragment thereof.

In the following, various aspects of the two uses stated in the twoparagraphs above are described and all these aspects could be combinedtogether. The skilled person realizes that the teaching in the followingsix pages are all combinable with each other and particular aspectcombining features from various parts of these pages will be consideredto be adequately disclosed to the skilled person. In addition, allembodiment combining all the various aspects below with selectingcanakinumab as IL-1β binding antibody or a functional fragmentcontaining the same variable domain as canakinumab will be regarded asespecially preferred.

In one aspect the subject has moderate PAD. Moderate PAD is associatedwith an ankle-brachial index (ABI) below 0.8. Patients with severeischemic disease and severe PAD has an ABI below 0.5 or below 0.4 andthese patients can also benefit from treatment with the methods and usesaccording to the present invention. In one embodiment the subject isexhibiting an ankle-brachial index between 0.5 and 0.85 in at least oneleg before treatment. In another embodiment, the subject is exhibitingan ankle-brachial index less than 0.5 in at least one leg or the subjectis exhibiting an ankle-brachial index less than 0.9 in at least one leg.

Moderate PAD is associated with the subject having symptomaticintermittent claudication, i.e., the patients exhibiting severe painwhen walking relatively short distances like some 100 m e.g., less than150 m or less than 400 m.

In one embodiment of any use of the invention, the subject has improvedvascular structure and function after 3 months of treatment or after 12months of treatment. In one embodiment, reduced plaque burden in theperipheral artery walls of said subject is observed after at least 3months of treatment or at least 12 months of treatment. The reducedplaque burden compared to before treatment in said subject can bedetermined in the superficial femoral artery after at least 3 months oftreatment or after at least 12 months of treatment. The improvements ofvascular structure and function can be determined by magnetic resonanceimaging (MRI).

The subject's ability to walk for 6 min will improve after treatmentwith the methods and uses according to the present invention.

IL-1β binding antibody or functional fragment thereof is administeredevery 2 weeks, twice a month, monthly, every 6 weeks, every 2 months,every 3 months, every 4 months, every 5 months, or every 6 months fromthe first administration. In one embodiment, said IL-1β binding antibodyor functional fragment thereof is administered monthly.

In other embodiments of the uses described above, said patient is to beadministered about 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85,90, 95, 100, 105, 110, 115, 120, 125, 130, 135, 140, 145, 150, 155, 160,165, 170, 175, 180, 185, 190, 195, 200, 205, 210, 215, 220, 225, 230,235, 240, 245, 250, 255, 260, 265, 270, 275, 280, 285, 290, 295, 300 mgor any combination thereof of said IL-1β binding antibody or functionalfragment thereof.

In one embodiment, the use comprises administering about 25, 50, 75, 80,100, 125, 150, 175, 200, 225, 250, 275, 300 mg or any combinationthereof of the IL-1β binding antibody or functional fragment thereof.The use comprises administering about 50 mg, about 80 mg or about 200 mgor about 300 mg of the IL-1β binding antibody or functional fragmentthereof.

In one embodiment, the use comprises administering about 150 mg of theIL-1β binding antibody or functional fragment thereof.

In another embodiment the use comprising administering the patient anadditional dose of about 25 mg to about 300 mg of the IL-1β bindingantibody or functional fragment thereof at week 2, week 4 or week 6 fromthe first administration.

In one embodiment of any use of the invention, said IL-1β bindingantibody or functional fragment thereof is an IL-1β binding antibody. Inone embodiment of any use of the invention, said IL-1β binding antibodyor functional fragment thereof is capable of inhibiting the binding ofIL-1β to its receptor and has a K_(D) for binding to IL-1β of about 50pM or less.

In other embodiments of any use of the invention said IL-1β bindingantibody is selected from the group consisting of:

-   -   a) an IL-1β binding antibody directed ton antigenic epitope of        human IL-1β which includes the loop comprising the Glu64 residue        of the mature IL-1β, wherein said IL-1β binding antibody is        capable of inhibiting the binding of IL-1β to its receptor, and        further wherein said IL-1β binding antibody has a K_(D) for        binding to IL-1β of about 50 pM or less;    -   b) an IL-1β binding antibody that competes with the binding of        an IL-1β binding antibody comprising a VH domain comprising SEQ        ID NO:1 and a VL domain comprising SEQ ID NO:2;    -   c) an anti-IL-1β binding antibody comprising the three CDRs of        SEQ ID NO:3, SEQ ID NO:4, SEQ ID NO:5;    -   d) an anti-IL-1β binding antibody comprising the three CDRs of        SEQ ID NO:6, SEQ ID NO:7, SEQ ID NO:8;    -   e) an anti-IL-1β binding antibody comprising the three CDRs of        SEQ ID NO:3, SEQ ID NO:4, SEQ ID NO:5 and the three CDRs of SEQ        ID NO:6, SEQ ID NO:7, SEQ ID NO:8;    -   f) an anti-IL-1β binding antibody comprising a VH domain        comprising SEQ ID NO:1;    -   g) an anti-IL-1β binding antibody comprising a VL domain        comprising SEQ ID NO:2;    -   h) an anti-IL-1β binding antibody comprising a VH domain        comprising SEQ ID NO:1 and a VL domain comprising SEQ ID NO:2.

In one embodiment of any use of the invention, said IL-1β bindingantibody or fragment thereof comprises the 3 CDRs of SEQ ID NO:1 are setforth in SEQ ID NO:3, 4, and 5 and comprises the 3 CDRs of SEQ ID NO:2are set forth in SEQ ID NO:6, 7, and 8.

In other embodiments of any use of the invention, said IL-1β bindingantibody or functional fragment thereof comprises:

a) a VH having a first CDR having 0, 1 or 2 amino acid substitutions incomparison to the CDR set forth in SEQ ID NO:3, a second CDR having 0, 1or 2 amino acid substitutions in comparison to the CDR set forth in SEQID NO:3, a third CDR having 0, 1 or 2 amino acid substitutions incomparison to the CDR set forth in SEQ ID NO:5; andb) a VL having a first CDR having 0, 1 or 2 amino acid substitutions incomparison to the CDR set forth in SEQ ID NO:6, a second CDR having 0, 1or 2 amino acid substitutions in comparison to the CDR set forth in SEQID NO:7, and a third CDR having 0, 1 or 2 amino acid substitutions incomparison to the CDR set forth in SEQ ID NO:8, wherein said antibodyhas a K_(D) for IL-1beta of 50 pM or less and wherein said antibodyinhibits the binding of IL-1β to its receptor.

Substituted amino acids are ideally conservative substitutions, and oncesubstituted a skilled artisan could use an assay such as those describedin WO02/16436.

In one embodiment of any use of the invention, said IL-1β bindingantibody is canakinumab. In other embodiments of any use of theinvention, said IL-1β binding antibody or functional fragment thereof isselected from the group consisting of gevokizumab, LY-2189102 orAMG-108.

In some embodiments of any of the use described above, said IL-1βbinding antibody or functional fragment thereof binds to human IL-1βwith a dissociation constant of about 50 pM or less. In someembodiments, the antibody or fragment binds to human IL-I 13 with adissociation constant of about 500 pM or less. In some embodiments, theIL-1β binding antibody or functional fragment thereof binds to humanIL-I 13 with a dissociation constant of about 250 pM or less. In someembodiments, the IL-1β binding antibody or functional fragment thereofbinds to human IL-1β with a dissociation constant of about 100 pM orless. In some embodiments of any of the uses described above, the IL-1βbinding antibody or functional fragment thereof binds to human IL-1βwith a dissociation constant of about 5 pM or less. In some embodiments,the IL-1β binding antibody or functional fragment thereof binds to humanIL-1β with a dissociation constant of about 1 pM or less. In someembodiments, the IL-1β binding antibody or functional fragment thereofbinds to human IL-1β with dissociation constant of about 0.3 pM or less.

In some embodiments of any of the uses described above, the IL-1βbinding antibody or fragment thereof is a neutralizing antibody.

In one aspect the IL-1β binding antibody, the canakinumab heavy chainvariable region (VH) is set forth as SEQ ID NO:1 of the sequencelisting. CDR1 of the VH of canakinumab is set forth as SEQ ID NO:3 ofthe sequence listing. CDR2 of the VH of canakinumab is set forth as SEQID NO:4 of the sequence listing. CDR3 of the VH of canakinumab is setforth as SEQ ID NO:5 of the sequence listing.

The canakinumab light chain variable region (VL) is set forth as SEQ IDNO:2 of the sequence listing. CDR1 of the VL of canakinumab is set forthas SEQ ID NO:6 of the sequence listing. CDR2 of the VL of canakinumab isset forth as SEQ ID NO:7 of the sequence listing. CDR3 of the VL ofcanakinumab is set forth as SEQ ID NO:8 of the sequence listing.

In some embodiments of any of the uses described above, the IL-1βbinding antibody or fragment thereof competes with the binding of anantibody having the light chain variable region of SEQ ID NO:1 and theheavy chain variable region of SEQ ID NO:2.

In some embodiments, the disclosed uses, said IL-1β binding antibodyhaving the three CDRs of SEQ ID NO:1. In further embodiments, the threeCDRs of SEQ ID NO:1 are set forth as SEQ ID NOs:3-5. In someembodiments, the disclosed uses comprise administering an anti-IL-1βbinding antibody having the three CDRs of SEQ ID NO:2. In furtherembodiments, the three CDRs of SEQ ID NO:2 are set forth as SEQ IDNOs:6-8.

In some embodiments, the disclosed uses comprise administering ananti-IL-1β binding antibody having the three CDRs of SEQ ID NO:1 and thethree CDRs of SEQ ID NO:2. In further embodiments, the three CDRs of SEQID NO:1 are set forth as SEQ ID NOs:3-5 and the three CDRs of SEQ IDNO:2 are set forth as SEQ ID NOs:6-8.

In some embodiments of any of the use described above, said IL-1βbinding antibody or functional fragment thereof is to be administeredsubcutaneously or intravenously.

When administered subcutaneously, canakinumab can be administered in areconstituted formulation from a lyophilisate comprising canakinumab ata concentration of 10-150 mg/ml, 270 mM sucrose, 30 mM histidine and0.06% polysorbate 80, wherein the pH of the formulation is 6.3-6.7,preferably 6.5.

When administered subcutaneously, canakinumab can be administered in aliquid formulation comprising canakinumab at a concentration of 10-200mg/ml, mannitol, histidine and polysorbate 80 (or polysorbate 20),wherein the pH of the formulation is 5.5-7.0, or more preferred 6.3-6.7,and preferably 6.5. In one aspect the formulation comprises 10-150mg/ml, 270 mM mannitol, 20 mM histidine and 0.04% polysorbate 80 (orpolysorbate 20), wherein the pH of the formulation is 6.3-6.7,preferably 6.5.

When administered subcutaneously, canakinumab or any of said IL-1βbinding antibody or functional fragment thereof can be administered tothe patient in a liquid form or lyophilized form for reconstitutioncontained in a prefilled syringe. In one embodiment said prefilledsyringe can be contained in an autoinjector. Such autoinjector makes itpossible for the patient to selfadminister the liquid formulationsubcutanously in an easy manner.

In other embodiments of any use according to the invention, said patientis concomitantly receiving a statin such as lovastatin, pravastatin,simvastatin, fluvastatin, atorvastatin, cerivastatin, mevastatin,pitavastatin, rosuvastatin Preferably said patient is concomitantlyreceiving simvastatin, atorvastatin, rosuvastatin or aspirin. In oneaspect, said patient is concomitantly receiving cilostazol orpentoxyfylline. In other aspects, said patient is concomitantlyreceiving beta-adrenergic blocking drugs such as esmolol, metoprolol,nadolol, penbutolol; or an angiotensin-converting enzyme (ACE) inhibitorsuch as ramipril, ramiprilat, captopril, lisinopril; or an angiotensinII receptor blocker such as losartan, valsartan, olmesartan, irbesartan,candesartan, telmisartan, eprosartan; or an inhibitor of plateletaggregation such clopidogrel, elinogrel, prasugrel, cangrelor,ticagrelor, ticlopidine, dipyridamole, picodamide eptifibatide,abciximab, eptifibatide, tirofiban or terutroban; or a nitrate such asglyceryl trinitrate (GTN)/nitroglycerin, isosorbide dinitrate,isosorbide mononitrate.

In another aspect the present invention provides a pharmaceuticalcomposition comprising 25 mg/ml to about 300 mg/ml of an IL-1β bindingantibody or functional fragment thereof for use as a medicament fortreating or alleviating the symptoms of peripheral arterial disease(PAD) in a subject. In some aspects, said composition comprise about 25,50, 75, 80, 100, 125, 150, 175, 200, 225, 250, 275, 300 mg/ml of theIL-1β binding antibody or functional fragment thereof.

Said composition comprise about 50 mg/ml, about 80 mg/ml, about 200mg/ml or about 300 mg/ml of the IL-1β binding antibody or functionalfragment thereof. Preferably, said composition comprises about 50 or 150mg/ml of the IL-1β binding antibody or functional fragment thereof.Preferably, said IL-1β binding antibody is canakinumab. In one aspectsaid composition is a reconstituted formulation comprising 10-200 mg/mlcanakinumab, 270 mM sucrose, 30 mM histidine and 0.06% polysorbate 80,wherein the pH of the formulation is 6.5.

In another aspect said composition is a liquid formulation comprising10-200 mg/ml canakinumab, mannitol, histidine and polysorbate 80,wherein the pH of the formulation is between 6.1-6.9, or 6.3-6.7. Inanother aspect said composition is a liquid formulation comprising10-200 mg/ml canakinumab, 270 mM mannitol, 20 mM histidine and 0.04%polysorbate 80, wherein the pH of the formulation is 6.5.

General:

All patents, published patent applications, publications, references andother material referred to herein are incorporated by reference hereinin their entirety.

As used herein, the term “comprising” encompasses “including” as well as“consisting,” e.g. a composition “comprising” X may consist exclusivelyof X or may include something additional, e.g., X+Y.

As used herein, the term “administering” in relation to a compound,e.g., an IL-1β binding antibody or standard of care agent, is used torefer to delivery of that compound by any route of delivery.

As used herein, the term “assaying” is used to refer to the act ofdetecting, identifying, screening, or determining, which act may beperformed by any conventional means. For example, a sample may beassayed for the presence of a particular marker by using an ELISA assay,a Northern blot, imaging, etc. to detect whether that marker is presentin the sample.

As used herein, The term “about” in relation to a numerical value xmeans, for example, +/−10%.

As used herein, The word “substantially” does not exclude “completely,”e.g., a composition which is “substantially free” from Y may becompletely free from Y. Where necessary, the word “substantially” may beomitted from the definition of the disclosure.

As used herein, “C-reactive protein” and “CRP” refers to serumC-reactive protein, which is used as an indicator of the acute phaseresponse to inflammation. The level of CRP in plasma may be given in anyconcentration, e.g., mg/dl, mg/L, nmol/L. Levels of CRP may be measuredby a variety of well known methods, e.g., radial immunodiffusion,electroimmunoassay, immunoturbidimetry, ELISA, turbidimetric methods,fluorescence polarization immunoassay, and laser nephelometry. Testingfor CRP may employ a standard CRP test or a high sensitivity CRP (hsCRP)test (i.e., a high sensitivity test that is capable of measuring lowlevels of CRP in a sample using laser nephelometry). Kits for detectinglevels of CRP may be purchased from various companies, e.g., Calbiotech,Inc, Cayman Chemical, Roche Diagnostics Corporation, Abazyme, DADEBehring, Abnova Corporation, Aniara Corporation, Bio-Quant Inc., SiemensHealthcare Diagnostics, etc.

As used herein, the term “hsCRP” refers to the level of CRP in the bloodas measured by high sensitivity CRP testing.

Each local laboratory will employ a cutoff value for abnormal (high) CRPbased on that laboratory's rule for calculating normal maximum CRP. Aphysician generally orders a CRP test from a local laboratory, and thelocal laboratory reports normal or abnormal (low or high) CRP using therule that particular laboratory employs to calculate normal CRP.

By “IL-1β binding antibody” is meant any antibody capable of binding tothe IL-1β antigen either alone or associated with other molecules. Thebinding reaction may be shown by standard methods (qualitative assays)including, for example, a bioassay for determining the inhibition ofIL-1β binding to its receptor or any kind of binding assays, withreference to a negative control test in which an antibody of unrelatedspecificity but of the same isotype, e.g. an anti-CD25 antibody, isused. Advantageously, the binding of the IL-1β binding antibodies usedin the methods of the invention to IL-1β may be shown in a competitivebinding assay.

As used herein the term “antibody” as referred to herein includes wholeantibodies and any antigen binding fragment or single chains thereof(i.e., “functional fragment”). A naturally occurring “antibody” is aglycoprotein comprising at least two heavy (H) chains and two light (L)chains inter-connected by disulfide bonds. Each heavy chain is comprisedof a heavy chain variable region (abbreviated herein as V_(H)) and aheavy chain constant region. The heavy chain constant region iscomprised of three domains, CH1, CH2 and CH3. Each light chain iscomprised of a light chain variable region (abbreviated herein as V_(L))and a light chain constant region. The light chain constant region iscomprised of one domain, CL. The V_(H) and V_(L) regions can be furthersubdivided into regions of hypervariability, termed complementaritydetermining regions (CDR), interspersed with regions that are moreconserved, termed framework regions (FR). Each V_(H) and V_(L) iscomposed of three CDRs and four FRs arranged from amino-terminus tocarboxy-terminus in the following order: FR1, CDR1, FR2, CDR2, FR3,CDR3, FR4. The variable regions of the heavy and light chains contain abinding domain that interacts with an antigen. The constant regions ofthe antibodies may mediate the binding of the immunoglobulin to hosttissues or factors, including various cells of the immune system (e.g.,effector cells) and the first component (C1q) of the classicalcomplement system.

As used herein, the term “functional fragment” of an antibody as usedherein, refers to portions or fragments of an antibody that retain theability to specifically bind to an antigen (e.g., IL-1β). It has beenshown that the antigen-binding function of an antibody can be performedby fragments of a full-length antibody. Examples of binding fragmentsencompassed within the term “functional fragment” of an antibody includea Fab fragment, a monovalent fragment consisting of the V_(L), V_(H), CLand CH1 domains; a F(ab)2 fragment, a bivalent fragment comprising twoFab fragments linked by a disulfide bridge at the hinge region; a Fdfragment consisting of the V_(H) and CH1 domains; a Fv fragmentconsisting of the V_(L) and V_(H) domains of a single arm of anantibody; a dAb fragment (Ward et al., 1989), which consists of a V_(H)domain; and an isolated complementarity determining region (CDR).Exemplary antigen binding sites include the CDRs of canakinumab as setforth in SEQ ID NOs: 3-5 and SEQ ID NOs: 6-8. Although the two domainsof the Fv fragment, V_(L) and V_(H), are coded for by separate genes,they can be joined, using recombinant methods, by a synthetic linkerthat enables them to be made as a single protein chain in which theV_(L) and V_(H) regions pair to form monovalent molecules (known assingle chain Fv (scFv); see, e.g., Bird et al., 1988; and Huston et al.,1988). Such single chain antibodies are also intended to be encompassedwithin the term “functional fragments” of an antibody. These antibodyfragments are obtained using conventional techniques known to those ofskill in the art, and the fragments are screened for utility in the samemanner as are intact antibodies.

As used herein, the terms “monoclonal antibody” or “monoclonal antibodycomposition” as used herein refer to a preparation of antibody moleculesof single molecular composition. A monoclonal antibody compositiondisplays a single binding specificity and affinity for a particularepitope.

As used herein, the term “human antibody”, as used herein, is intendedto include antibodies having variable regions in which both theframework and CDR regions are derived from sequences of human origin.Furthermore, if the antibody contains a constant region, the constantregion also is derived from such human sequences, e.g., human germlinesequences, or mutated versions of human germline sequences or antibodycontaining consensus framework sequences derived from human frameworksequences analysis as described in Knappik, et al. A “human antibody”need not be produced by a human, human tissue or human cell. The humanantibodies of the disclosure may include amino acid residues not encodedby human sequences (e.g., mutations introduced by random orsite-specific mutagenesis in vitro or by somatic mutation in vivo).However, the term “human antibody”, as used herein, is not intended toinclude antibodies in which CDR sequences derived from the germline ofanother mammalian species, such as a mouse, have been grafted onto humanframework sequences.

As used herein, the term “K_(D)”, as used herein, is intended to referto the dissociation constant, which is obtained from the ratio of K_(d)to K_(a) (i.e. K_(d)/K_(a)) and is expressed as a molar concentration(M). K_(D) values for antibodies can be determined using methods wellestablished in the art. A method for determining the K_(D) of anantibody is by using surface plasmon resonance, or using a biosensorsystem such as a Biacore® system.

As used herein, the term “patient” includes any human or nonhumananimal. The term “nonhuman animal” includes all vertebrates, e.g.,mammals and non-mammals, such as nonhuman primates, sheep, dogs, cats,horses, cows, chickens, amphibians, reptiles, etc.

As used herein, an antibody that “inhibits” one or more of these IL-1βfunctional properties (e.g., biochemical, immunochemical, cellular,physiological or other biological activities, or the like) as determinedaccording to methodologies known to the art and described herein, willbe understood to relate to a statistically significant decrease in theparticular activity relative to that seen in the absence of the antibody(or when a control antibody of irrelevant specificity is present). Anantibody that inhibits IL-1β activity affects a statisticallysignificant decrease, e.g., by at least 10% of the measured parameter,by at least 50%, 80% or 90%, and in certain embodiments an antibody ofthe disclosure may inhibit greater than 95%, 98% or 99% of IL-17functional activity.

As used herein the term “polypeptide”, if not otherwise specifiedherein, includes any peptide or protein comprising amino acids joined toeach other by peptide bonds, having an amino acid sequence starting atthe N-terminal extremity and ending at the C-terminal extremity.

Example 1

A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study of theSafety, Tolerability and Effects on Arterial Structure and Function ofACZ885 in Patients with Intermittent Claudication

Because ACZ885 (canakinumab) does not cross-react with rodent, canine orpig IL-1β, preclinical efficacy data with this antibody in other specieshave not been obtained. However, supportive data is available fromreports of reduced atherosclerosis in IL-1 knockout or IL-1 type Ireceptor knockout mice (Kirii, et al., 2003). IL-1 receptor antagonistdeficient mice are more prone to neointima development after endotheliainjury and more prone to atherogenesis (Isoda et al, m 2003; Isoda andOhsuzu, 2006). Independent of atherosclerosis, the effects of IL-1βblockade on infarct size after coronary ligation or ischemia-reperfusionhas been assessed in IL-1R1 knockout mice, and in mice treated withanakinra or IL-1β antibodies. In these studies, the blockade of IL-1signaling is either protective or neutral (Abbate et al 2008; Salloum etal 2009). A single report (Hwang et al 2001) showed thatco-administration of an anti-IL-1β antibody in an infarction model inC57BL/6 mice worsened mortality and increased rupture of the ventricularwall, but was complicated by a higher-than-normal 24-hour perioperativemortality rate in the control groups. Mice have limited collateralcoronary circulations and the extent of these collateral vessels arestrain-dependent. Thus these in vivo studies may have limited ability toreflect the complex multifactorial interactions that modulate IL-1βresponses in humans.

In this study, subjects will be selected to be at least 3 months fromprevious events requiring healing processes, e.g. myocardial infarction,coronary artery bypass grafting, stroke, or carotid endarterectomy, toallow for adequate wound healing.

The objectives of this study are:

-   -   To assess the effect of ACZ885 on peripheral artery total plaque        burden using MRI techniques at baseline, 3 months and 12 months.    -   To assess the effect of ACZ885 on serum amyloid A protein,        high-sensitivity C-reactive protein and Interleukin-6 levels    -   To assess the effect of ACZ885 on functional capacity        parameters, as measured by a 6 minute walk test, including        pain-free walk distance and maximum walk distance.    -   To explore the effects of ACZ885 on functional capacity, as        measured by outpatient activity levels (average number of steps        taken daily and average time upright daily) documented by the        activPAL device)

The ActivPAL™ monitor (PAL Technologies Ltd., Glasgow, UK) will be used.This device's accuracy is well documented, it provides more detailedinformation than some other monitors, and this has been used in othercancer studies (Maddocks et al 2011). The device is a small andlightweight (20×30×5 mm, 20 g) uniaxial accelerometer that is applied tothe anterior thigh using adhesive PALStickies™ and a layer of Tegaderm™dressing. The ActivPAL™ records periods spent sitting, standing andwalking, sit-to-stand transitions, step count and rate of stepping(cadence) over a maximum period of 10 days with a fully charged newbattery.

Accompanying software allows each of these outcomes to be displayed byhour, day or week. During the study the device will be worn for 6consecutive days. These devices may be removed at night or kept on butshould be removed during bathing, showering, or swimming. The monitoralso provides an estimate of energy expenditure in metabolic equivalenthours (METh), based on the time spent sitting, standing, walking andcadence; however, this outcome has not been validated.

-   -   To explore the effects of ACZ885 on serum D-dimer levels and in        an ex vivo cholesterol efflux in vitro assay    -   To explore the effects of ACZ885 on the incidence of adjudicated        major cardiovascular events and on peripheral arterial events

This is a non-confirmatory, double-blind, randomized,placebo-controlled, parallel group study in patients with intermittentclaudication. The study will consist of a 28 day screening period, a 28day run-in period with initiation of a standardized exercise regimen, a12 month treatment period and a 1 month follow-up period. MRI of theperipheral vessels will be obtained at the end of the run-in period(considered ‘baseline’), and after 3 and 12 months of treatment.Additional assessments will include functional tests (6 minute walktest) and other objective measures of functional capacity (ActivPALrecorded outpatient activity) after 1, 2, 3, 6, 9 and 12 months oftreatment. This design will allow for the assessment of both potentialacute and chronic effects of ACZ885 on peripheral artery disease inthese patients, as well as allow for an expeditious assessment of anysafety concerns. Patients who meet the eligibility criteria at screeningwill be admitted to baseline evaluations. All baseline safety evaluationresults must be available prior to dosing. Patients will attend thestudy site the day before dosing in each period for baselineevaluations. Following a single dose of ACZ885, pharmacokinetic,pharmacodynamic, and safety assessments will be done. Patients will thenundergo Study Completion evaluations approximately 30 days after theirlast dose. Safety assessments will include physical examinations, ECGs,vital signs, standard clinical laboratory evaluations (hematology, bloodchemistry, urinalysis) adverse event and serious adverse eventmonitoring.

Subjects who meet the inclusion/exclusion criteria at screening will beadmitted to baseline evaluations. All baseline safety evaluation resultsmust be available prior to dosing.

Subjects will attend the study site the day before dosing in each periodfor baseline evaluations. Following a single dose of ACZ885,pharmacokinetic, pharmacodynamic, and safety assessments will be madeduring monthly visits over 12 months. Subjects will then undergo StudyCompletion evaluations approx 30 days after their last dose.

Safety assessments will include physical examinations, ECGs, vitalsigns, standard clinical laboratory evaluations (hematology, bloodchemistry, urinalysis) adverse event and serious adverse eventmonitoring.

This study is a randomized, placebo-controlled, double-blind study. Thedesign of this study addresses the primary objective of evaluating thechange in vascular structure and functional capacity in patients withperipheral artery disease and intermittent claudication as a result oftreatment with ACZ885. Patients with an ankle-brachial index of between0.50 and 0.85 (inclusive) will be enrolled as ABI is a predictivemeasure of impaired vascular blood flow to the lower extremities. Withinthis population, patients will additionally selected, who have a 6minute walk distance of ≤400 m (based published data in subjects withmeasurable plaque volume via MRI having walk distances below 400 m(McDermott 2011)). Some measures of peripheral artery disease severity(e.g. walk distances) can be influenced by psychosocial cues such asverbal encouragement or perception of pain, or the knowledge of drugadministration. Therefore this study is double-blinded to mitigate theseeffects. Enrollment in studies is also known to positively impactpatients' motivation to exercise, which in turn improves walk distance.Therefore to minimize variability from being enrolled in the study, allpatients will be enrolled in a standardized home exercise programbeginning in the one month run-in period, and lasting through theduration of treatment.

As there are no currently approved or effective therapies known tomediate disease progression in PAD, placebo will be used to aim indemonstrating an effect of ACZ885 on PAD. Patients will be maintained ontheir stable regimen, including aspirin and statin, as recommended forPAD risk modification.

Approximately 180 subjects will be enrolled to participate in the studyand randomized, with a goal of at least 120 patients expected tocomplete the study.

Subjects eligible for inclusion in this study have to fulfill all of thefollowing criteria:

-   1. Male and female subjects age 18 to 74 years of age (inclusive) at    screening, with clinical evidence of moderate peripheral artery    disease. This must be demonstrated by an ankle-brachial index of    0.5-0.8 (inclusive) in at least one leg.-   2. Moderate symptomatic intermittent claudication, as defined by    pain and/or fatigue in any of the leg muscles with ambulation of    less than 400 meters. Atypical symptoms may also be considered at    the discretion of the investigator, including but not limited to    parasthesias, pallor and coolness of the lower peripheral limbs with    ambulation.-   3. On stable aspirin and statin therapy for at least 6 weeks prior    to screening, or have documentation of intolerance. If patients are    not on an aspirin or statin, they must have a documented    contraindication, e.g. GI distress with aspirin, or statin    intolerance or myopathy.-   4. Acquisition of evaluable MRI images at baseline to assess the    vessel wall morphometry of the superficial femoral artery to    determine plaque burden and regions of stenosis.-   5. At Screening, and Baseline, vital signs (systolic and diastolic    blood pressure and pulse rate) will be assessed in the sitting    position after the subject has rested for at least five (5) minutes.    An appropriately sized BP cuff should be used for the given    subject's body habitus. Vital signs should be within:    -   oral body temperature between 35.0-37.5° C.    -   systolic blood pressure, 90-170 mm Hg    -   diastolic blood pressure, 50-100 mm Hg    -   pulse rate, 40-100 bpm

The investigational drug, ACZ885 and matching placebo will be preparedby Novartis as lyophilized powder in glass vials and supplied to theclinical sites as open label bulk medication. Please see pharmacy manualfor details of preparation. The drug will be delivered at a dose of 150mg subcutaneously monthly for a treatment period of 12 months.

Subjects will be assigned to one of the following 2 treatments in aratio of 1:1

Study treatments are defined as:

-   -   Monthly doses of 150 mg ACZ885    -   Monthly doses of placebo to 150 mg ACZ885

REFERENCES

-   Abbate A, Salloum F N, Veci E. et al (2008) Anakinra, a recombinant    human interleukin-1 receptor antagonist, inhibits apoptosis in    experimental acute myocardial infarction. Circulation 117:2670-2683-   Crossman D C, Morton A C, Gunn J P et al (2008) Investigation of the    effect of Interleukin-1 receptor antagonist (IL-1ra) on markers of    inflammation in non-ST elevation acute coronary syndromes. (The    MRC-ILA-HEART study). Trials; 9:8-21-   Hwang M W, Matsumori A, Furukawa Y, et al (2001) Neutralizaqtion of    interleukin-1 beta in the acute phase of myocardial infarction    promotes the progression of left ventricular remodeling. J Am Coll    Cardiol; 38:1546-53-   Isoda K and Ohsuzu F (2006) The effect of interleukin-1 receptor    antagonist on arteries and cholesterol metabolism. J Atheroscler    Thromb; 13:21-30-   Isoda K, Shiigai M, Ishigami H et al (2003) Deficiency of    interleukin-1 receptor antagonist promotes neointimal formation    after injury. Circulation 108:516-8-   Kirii H, Niwa T, Yamada Y, et al (2003) Lack of interleukin-1 beta    decreases the severity of atherosclerosis in ApoE-deficient mice.    Arterioscler Thromb Vasc Biol 23:656-60-   Salloum F N, Chau V, Varma A et al (2009) Anakinra in experimental    acute myocardial infarction—does dosage or duration of treatment    matter? Cardiovasc Drugs Ther 23:129-135

SEQUENCE LISTING <110> Novartis AG <160> 8 <170> PatentIn version 3.5<210> 1 <211> 118 <212> PRT <213> homo sapiens <400> 1Gln Val Gln Leu Val Glu Ser Gly Gly Gly Val Val Gln Pro Gly Arg1               5                   10                  15Ser Leu Arg Leu Ser Cys Ala Ala Ser Gly Phe Thr Phe Ser Val Tyr            20                  25                  30Gly Met Asn Trp Val Arg Gln Ala Pro Gly Lys Gly Leu Glu Trp Val        35                  40                  45Ala Ile Ile Trp Tyr Asp Gly Asp Asn Gln Tyr Tyr Ala Asp Ser Val    50                  55                  60Lys Gly Arg Phe Thr Ile Ser Arg Asp Asn Ser Lys Asn Thr Leu Tyr65                  70                  75                  80Leu Gln Met Asn Gly Leu Arg Ala Glu Asp Thr Ala Val Tyr Tyr Cys                85                  90                  95Ala Arg Asp Leu Arg Thr Gly Pro Phe Asp Tyr Trp Gly Gln Gly Thr            100                 105                 110Leu Val Thr Val Ser Ser         115 <210> 2 <211> 107 <212> PRT <213>homo sapiens <400> 2Glu Ile Val Leu Thr Gln Ser Pro Asp Phe Gln Ser Val Thr Pro Lys1               5                   10                  15Glu Lys Val Thr Ile Thr Cys Arg Ala Ser Gln Ser Ile Gly Ser Ser            20                  25                  30Leu His Trp Tyr Gln Gln Lys Pro Asp Gln Ser Pro Lys Leu Leu Ile        35                  40                  45Lys Tyr Ala Ser Gln Ser Phe Ser Gly Val Pro Ser Arg Phe Ser Gly    50                  55                  60Ser Gly Ser Gly Thr Asp Phe Thr Leu Thr Ile Asn Ser Leu Glu Ala65                  70                  75                  80Glu Asp Ala Ala Ala Tyr Tyr Cys His Gln Ser Ser Ser Leu Pro Phe                85                  90                  95Thr Phe Gly Pro Gly Thr Lys Va Asp Ile Lys            100                105 <210> 3 <211> 5 <212> PRT <213>HOMO SAPIENS <400> 3 Val Tyr Gly Met Asn 1               5 <210> 4 <211>17 <212> PRT <213> HOMO SAPIENS <400> 4Ile Ile Trp Tyr Asp Gly Asp Asn Gln Tyr Tyr Ala Asp Ser Val Lys1               5                   10                  15 Gly <210> 5<211> 6 <212> PRT <213> HOMO SAPIENS <400> 5 Asp Leu Arg Th Gly Pro1              5 <210> 6 <211> 11 <212> PRT <213> HOMO SAPIENS <400> 6Arg Ala Ser Gln Ser Ile Gly Ser Ser Leu His1                5                  10 <210> 7 <211> 6 <212> PRT <213>HOMO SAPIENS <400> 7 Ala Ser Gln Ser Phe Ser 1               5 <210> 8<211> 7 <212> PRT <213> HOMO SAPIENS <400> 8 His Gln Ser Ser Ser Leu Pro1               5

1. A method for treating or alleviating the symptoms of peripheralarterial disease (PAD) in a subject, comprising administering about 25mg to about 300 mg canakinumab, wherein the subject is exhibiting anankle-brachial index less than 0.9 in at least one leg before treatment.2. The method according to claim 1, wherein the subject has moderatePAD.
 3. (canceled)
 4. The method according to claim 1, wherein thesubject is exhibiting an ankle-brachial index between 0.5 and 0.85 in atleast one leg before treatment.
 5. The method according to claim 1,wherein the subject is exhibiting an ankle-brachial index less than 0.5in at least one leg before treatment.
 6. The method according to claim1, wherein the subject has symptomatic intermittent claudication.
 7. Themethod according to claim 1, wherein the subject has improved vascularstructure and function after 3 months of treatment.
 8. The methodaccording to claim 1, wherein the subject has improved vascularstructure and function after 12 months of treatment.
 9. The methodaccording to claim 1, wherein reduced plaque burden in the peripheralartery walls of the subject is observed after at least 3 months oftreatment.
 10. The method according to claim 1, wherein reduced plaqueburden in the peripheral artery walls of the subject is observed afterat least 12 months of treatment
 11. The method according to claim 1,wherein a reduced plaque burden compared to before treatment in thesubject is determined in the superficial femoral artery after at least 3months of treatment.
 12. The method according to claim 1, wherein areduced plaque burden compared to before treatment in the subject isdetermined in the superficial femoral artery after at least 12 months oftreatment.
 13. (canceled)
 14. The method according to claim 1, whereincanakinumab is administered every 2 weeks, twice a month, monthly, every6 weeks, every 2 months, every 3 months, every 4 months, every 5 months,or every 6 months from the first administration.
 15. (canceled)
 16. Themethod according to claim 1, wherein the method comprises administeringabout 25, 50, 75, 80, 100, 125, 150, 175, 200, 225, 250, 275, 300 mg orany combination thereof canakinumab to the subject.
 17. The methodaccording to claim 1, wherein the method comprises administering about150 mg to about 300 mg canakinumab to the subject. 18-21. (canceled) 22.The method according to claim 1, further comprising administering anadditional dose of about 25 mg to about 300 mg canakinumab to thesubject at week 2, week 4, or week 6 from the first administration.23-29. (canceled)
 30. The method according to claim 1, whereincanakinumab is administered subcutaneously.
 31. The method according toclaim 30, wherein canakinumab is administered in a reconstitutedformulation comprising canakinumab at a concentration of 10-200 mg/ml,270 mM sucrose, 30 mM histidine and 0.06% polysorbate 80, wherein the pHof the formulation is 6.5.
 32. The method according to claim 30, whereincanakinumab is administered in a liquid formulation comprisingcanakinumab at concentration: 10-200 mg/ml, mannitol, histidine andpolysorbate 80, wherein the pH of the formulation is 6.1-6.9.
 33. Themethod according to claim 1, wherein canakinumab is administered to thesubject in a liquid form or lyophilized form for reconstitutioncontained in a prefilled syringe.
 34. The method according to claim 33,wherein the prefilled syringe is contained in an autoinjector. 35-88.(canceled)